Support for health and wellbeing boards and their partners in developing joint strategic needs assessments (JSNAs) and health and wellbeing strategies has been published in the form of draft statutory guidance.

Views are now being sought on the draft guidance, which:

lays out the statutory duties that underpin the production of JSNAs and joint health and wellbeing strategies by the NHS and local authorities (as members of their health and wellbeing board)

describes a framework that will lead to best practice in the preparation of JSNAs and assist with undertaking new joint health and wellbeing strategies

explains how JSNAs, joint health and wellbeing strategies and commissioning plans fit together in the new system

sets out how the enhanced JSNA process and joint health and wellbeing strategy will enable the NHS and local government, working with their community and partner organisations, to make real improvements to the health and wellbeing of local people.

I support references to the potential application of the JSNA to local planning (town and country planning) in relation to helping to improve health and well-being of communities and places. I would suggest more robust reference to linkages with the planning system by referencing the Local Plan preparation process, to which the JSNA must have a role.

I would like to see greater emphasis on addressing determinants of health, such as education and employment. Job Centre Plus is mentioned in the document; I would like to see explicit mention of bodies that can provide information and advice on both the unemployed and those in employment who may need support to retain employment (e.g. those with health needs, or on long-term sickenss absence). Such organisations might include local NHS occupational health services. the evidence to support this can be found in Dame Carol Black’s report: http://www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf thankyou.

English Community Care Association (ECCA) members provide a range of services for younger adults and older people with care and support needs. All of these services are delivered within a framework of personalised care and include:
• Community based support
• Domiciliary care
• Assisted living including sheltered and supported housing, extra care housing, retirement villages
• Residential care including many specialist care home services, short breaks, rehabilitation, palliative care, mental health services

ECCA members come from all parts of the independent sector, both charitable and commercial, including both small and large employers. ECCA members provide over 5000 service delivering care and support to more than 500,000 people.

When reading this document, we noted that the plans for health and wellbeing boards take very little into consideration with respect to care providers – the actual services being used.

The independent care sector is made up of thousands of services, the majority of which are small to medium sized enterprises. It is vital that in implementing the health and wellbeing strategies, the importance of good commissioning and communication with providers is understood. Whilst the sector has capacity to deliver high quality frontline services it has not always have the capacity to be able to input to local strategies, consultations etc, in the same way as councils and PCT’s currently can.

The services ECCA members provide are integrated health and social care services. Regretfully the surrounding health and social care services delivered by councils and NHS bodies are not always as integrated. However, integration is seen as a key objective of health and wellbeing boards.
To quote the above paper, in the Statutory Duties section;
‘There is a requirement for health and wellbeing boards to encourage integrated working between commissioners of health and social care services. In particular they must provide advice assistance or other support as they think appropriate for the purpose of encouraging the making of arrangements under section 75 of the NHS Act 2006 in connection with the provision of health and social care services. These arrangements include the pooling of funds, lead commissioning and integrated provision. As such it is anticipated that the health and wellbeing boards will not only have a role in promoting and supporting better integrated working between commissioners, but also arrangements for integrated provision – joining up social care, public health and NHS services’
We would ask:
• How are health and wellbeing boards going to achieve this?
• What are the plans for working with providers of social care on integration and supporting independent providers in delivering high quality person-centred care?

It is important for all parties to consider these questions sooner rather than later, or problems with health integration may persist. We will look forward to receiving more detail on these matters. Thank you.

I wish to support Sian Williams’ comment (above). Good work – that is good working environments and well managed work activities – is good for health. But there is also evidence of the converse – from long-term musculo skeletal problems (ergonomics), respiratory diseases such as asbestosis (chemical agents), harms such as noise induced hearing loss (physical agents). To fully address well-being requires a more joined up approach across agencies such as the Health and Safety Executive and linkage to other initiatives such as those stimulated by Dame Carol Black’s work, so that the workplace becomes not only a suitable venue for health promotion but also a haven from significant health risk exposures.

Such an approach also offers additional measures of success of any programme, such as the reduction in days lost from productive work through sickness absence or ill-health presenteeism.

Following a recent eentimg with Professor Field I would like to formally give my views on the idea of abolishing General Practice boundaries. I feel very strongly that this would be a mistake. I understand there are concerns regarding GP access, that public feedback is for ever more flexible access as well as issues around reaching “hard to reach” groups. Nevertheless my belief is that one of the great strengths of GP care is continuity of care within a practice. My own experience is that where patients see doctors who are not familiar with their care history more investigations are ordered and more inappropriate referrals made. This depth of knowledge of the patient and their surrounding social situation does not (and probably cannot) rest within the computerised patient record. The more complex the issues, the more continuity is essential. We all accept there are occasions when clinical need means seeing an unfamiliar GP is unavoidable but this should be the exception not the rule. Even in a large practice it is usual for patients to be known by at least 2 GPs and problems can be discussed easily within the practice team.This is not to say that General Practice is perfect but that does not mean we must implement ideas which are likely to make patient care worse rather than better.The NHS is facing severe cost limitations and reorganisations are being made. CCGs are being tasked to take on the mantle of front line leadership. At such a time it seems perverse to push through a populist policy that the majority of grass roots GPs oppose.In addition CCGs are being directed to ensure they are co-terminus with Local Authorities where possible and that practices should be within a CCG boundary. Again it appears perverse to push for a system where patients could end up being in different CCG footprints with different LAs. The main focus in care has moved to health outcomes which I feel is entirely appropriate. I don’t believe better health related outcomes might reasonably be expected to flow from such a policy. Evidence shows that care is best delivered by committed teams who are able to forge strong working relationships. Patients may believe that they will get more convenient care popping to a centre opposite their workplace however I don’t believe that it is likely that there will be better care by attending multiple sites. The evidence is to the contrary.